Occupational diseases

The occupational disease according to BK 3102 (BK no. 3102) covers those infections and their clinical pictures that are transmitted from animals to humans. According to the WHO, > 200 zoonoses are known, some of which also occur in Germany. There is a particular risk of infection among people who are professionally involved in animal husbandry and care or have other professional contact with animals, animal products or excretions. This includes handling materials that have come into contact with infected animals and their parts or excretions. An occupational group-typical risk of infection for zoonoses can therefore occur in the following occupational groups:

• Agricultural and veterinary staff
• Slaughterhouse personnel
• Employees in animal laboratories
• Employees in hunting and forestry
• Employees in rendering plants
• Employees in zoological gardens, game reserves and pet shops
• Persons who have professional contact with meat, fish, milk, eggs, hides, skins, furs, animal bristles, hair, feathers and bones
• Persons with contact to infectious material in sewage disposal.

Most zoonoses occur in other countries and may have to be taken into consideration by business travelers, development workers, fitters, tour guides, etc. after a stay abroad.

Guiding principle: A particularly high risk of infection is sufficient for exposure in the sense of the occupational disease "Diseases transmissible from animals to humans" (number 3102).

The following diseases can occur in Germany, classified according to pathogen groups:

• A00-A09 Infectious intestinal diseases
• A15-A19 Tuberculosis
• A20-A28 Certain bacterial zoonoses
• A30-A49 Other bacterial diseases
• A65-A69 Other spirochete diseases
• A70-A74 Other diseases caused by chlamydia
• A75-A79 Rickettsioses
• A80-A89 Viral infections of the central nervous system
• A92-A99 Arthropod-borne viral diseases and viral hemorrhagic fevers
• B00-B09 Viral infections characterized by skin and mucous membrane lesions
• B15-B19 Viral hepatitis
• B25-B34 Other viral diseases
• B35-B49 Mycoses
• B50-B64 Protozoal diseases
• B65-B83 Helminthoses
• B95-B98 Bacteria, viruses and other infectious agents as causes of diseases classified in other chapters
• J09-J18 Influenza and pneumonia

Diagnoses and clinical pictures in detail

• A02 Other salmonella infections
• A03 Shigellosis (bacterial dysentery)
• A04.3 Intestinal infection caused by enterohaemorrhagic Escherichia coli (EHEC)
• A04.5 Enteritis due to Campylobacter
• A04.6 Enteritis caused by Yersinia enterocolitica
• A06 Amoebiasis
• A07.0 Balantidiosis, incl. balantidial dysentery
• A07.1 Giardiasis (lambliasis)
• A07.2 Cryptosporidiosis
• A07.8 Other specified intestinal diseases caused by protozoa, incl. intestinal trichomoniasis, sarcosporidiosis
• A08.0 Enteritis caused by rotaviruses
• A15 "Tuberculosis of respiratory organs, bacteriologically, molecularly or histologically confirmed"
• A16 Tuberculosis of respiratory organs, not confirmed by bacteriology, molecular biology or histology
• A17 Tuberculosis of the nervous system
• A18 Tuberculosis of other organs
• A19 Miliary tuberculosis
• A20 Plague
• A21 Tularemia
• A22 Anthrax (anthrax)
• A23 Brucellosis
• A25 Rat-bite diseases
• A26 Erysipeloid
• A27 Leptospirosis
• A28.0 Pasteurellosis
• A28.1 Cat scratch disease
• A28.2 Extraintestinal yersiniosis
• A31.1 Infection of the skin caused by other mycobacteria, incl. Buruli ulcer, swimming pool granuloma
• A32 Listeriosis
• A36 Diphtheria
• A41.5 Sepsis caused by other gram-negative pathogens
• A49.8 Other bacterial infections of unspecified localization, other diseases caused by Campylobacter bacteria, enteritis under A04.5
• A69.2 Lyme borreliosis
• A70 Infections caused by Chlamydia psittaci
• A74 Other diseases caused by chlamydia
• A78 Q fever
• A82 Rabies
• A83.1 Western equine encephalitis
• A83.2 Eastern equine encephalitis
• A84.1 Central European tick-borne encephalitis, incl. Central European tick-borne encephalitis [TBE]
• A87.0 Meningitis due to enteroviruses, incl. swine vesicular disease
• A87.2 Lymphocytic choriomeningitis
• A96.0 Hemorrhagic fever due to Junin viruses
• A96.1 Hemorrhagic fever due to Machupo viruses
• A96.8 Other hemorrhagic fever due to arenaviruses
• A97 Dengue fever
• A98.0 Crimean-Congo hemorrhagic fever
• A98.1 Omsk hemorrhagic fever
• A98.2 Kyasanur forest disease
• A98.3 Marburg virus disease
• A98.5 Hemorrhagic fever with renal syndrome, incl. epidemic nephropathy; epidemic, Korean, Russian hemorrhagic fever; hantavirus disease with renal involvement; infection by hantan viruses
• B00.4 Encephalitis due to herpes viruses
• B04 Monkeypox
• B08.0 Other infections caused by orthopoxviruses, incl. cowpox; Orfvirus disease(ecthyma contagiosum), pseudocowpox(milker's nodes)
• B08.8 Other specified viral infections characterized by skin and mucous membrane lesions, incl. foot-and-mouth disease
• B17.2 Acute viral hepatitis E
• B30.8 Other conjunctivitis due to viruses, incl. Newcastle keratoconjunctivitis
• B35 Dermatophytosis(tinea)
• B42 Sporotrichosis
• B45 Cryptococcosis
• B58 Toxoplasmosis
• B60.0 Babesiosis
• B66.1 Clonorchiasis
• B67 Echinococcosis
• B68.0 Infestation by Taenia solium
• B68.1 Infestation by Taenia saginata
• B69 Cysticercosis, incl. infection by larvae of the pork tapeworm
• B70 Diphyllobothriosis and sparganosis
• B71.0 Hymenolepiasis
• B75 Trichinellosis
• B77 Ascaridosis
• B78 Strongyloidosis
• B83.0 Larva migrans/visceralis, incl. toxocariasis
• B95.4 Other streptococci as cause of diseases classified in other chapters
• J16.0 Pneumonia due to chlamydia
• P00.2 Damage to the fetus and newborn due to infectious and parasitic diseases of the mother
• Z22.7 Latent tuberculosis, only immunologically confirmed
• Occupational disease according to BK 3102 caused by other pathogens, e.g. mites as pathogens of scabies, animal mange, etc. can be transmitted when handling animal material.

Zoonoses are caused by bacteria (including chlamydia and rickettsia), viruses, fungi and parasites (protozoa, helminths or arthropods). It is currently being discussed whether they can also be caused by prions (abbreviation of proteinaceous infectious particles). Pathogens can enter the human body via the skin or mucous membranes after contact with infected animals, animal material or similar; this is also possible by inhaling air contaminated with pathogens or via the digestive tract, e.g. via contaminated hands (dirt or smear infection). The main reservoirs of pathogens are mammals - horses, cattle, sheep, goats, pigs, dogs, cats, bats, hamsters, mice, rats, hedgehogs - and birds as well as fish. Latently infected animals can also contribute to the maintenance of pathogens as reservoirs. The transmission of pathogens is often linked to arthropods (insects, ticks or arachnids) and rodents. Rodents, flies, cockroaches or pharaoh ants in particular can transmit disease-causing pathogens mechanically to susceptible hosts (humans or animals) and media. Known vectors (carriers of pathogens or food spoilage agents) and reservoirs (intermediate hosts of parasites) are ticks, flies, biting flies, cockroaches, horseflies, fleas, lice, rats and mice. In addition to living vectors, there are also inanimate vectors such as water, dust, air, animal waste, care objects, etc. After an incubation period typical of any infection, during which the pathogens multiply, the symptoms of the disease generally begin (suddenly). The incubation period varies depending on the number and transmission route of the pathogens and the individual disposition of the infected person.

A full pension is paid in the event of complete loss of earning capacity (100%). This amounts to two thirds of the annual earnings before the accident at work or occupational disease.

In the event of a partial reduction in earning capacity (MdE), the part of the full pension corresponding to the degree of reduction in earning capacity is paid - partial pension. An entitlement to a partial pension exists from a reduction in earning capacity of at least 20 percent.

Example: The pension of an insured person with a JAV of 36,000 euros and a reduction in earning capacity of a) 100 % and b) 20 % is calculated as follows:

Full pension = 2/3 of 36,000 = EUR 24,000, of which 100 % MdE = EUR 24,000 pension / year = EUR 2,000 pension / month

Partial pension = 2/3 of 36,000 = 24,000, of which 20 % MdE = 4,800 EUR pension / year = 400 EUR pension / month.

The presence of the respective pathogen at the workplace is a prerequisite for the justified suspicion of the existence of an occupational disease, as is a temporal connection to the exposure. The disease must develop within a period that is within the incubation period.

In the case of inapparent diseases, the development of the relevant stage and the possible subsequent state of the infectious disease should be considered; the route of transmission and infectivity of the pathogen should also be taken into account. Complications and permanent damage can occur in particular with brucellosis, enterohaemorrhagic E. coli infections, TBE, leptospirosis, Lyme borreliosis, Q fever, tuberculosis and enteric yersiniosis.

If diseases are not transmitted from animals to humans but from humans to humans, BK No. 3101 may apply.

With regard to damage to a foetus as a result of an occupational infection of the pregnant woman with a zoonosis (e.g. chlamydiosis, leptospirosis, listeriosis, Lyme borreliosis, toxoplasmosis) during the respective pregnancy, compensation for the child must be considered in accordance with § 12 SGB VII.

The zoonotic status of encephalomyelitis caused by Bornaviruses, which has been observed in horses in Germany, has not yet been reliably clarified. The identity of the viruses isolated from horses and humans has not yet been proven.

To date, no human spongiform encephalopathies caused by the transmission of BSE (bovine spongiform encephalopathy) pathogens have been identified as a disease with the characteristics of an occupational disease. This also applies to related TSE (transmissible spongiform encephalopathy) pathogens such as the scrapie agent, which only affects sheep and goats. Suspected cases should nevertheless be reported.

Case law (Federal Social Court judgment of 30.03.2023, B 2 U 2/21 R) According to established case law, in order to establish a listed BK (insured event), it is necessary that the performance of a fundamentally insured activity (factual connection) has led to the effects of stress, pollutants or similar on the body (causality of effects) and that these effects have caused an illness (causality giving rise to liability). The insured activity, the performance, the effects and the illness must be present in the sense of full proof, i.e. with a probability bordering on certainty. For the causal connections to be assessed according to the theory of the essential condition, however, sufficient probability is sufficient, but not mere possibility. The degree of proof of sufficient probability is fulfilled if there is more evidence for than against the causal link and serious doubts are excluded. The fact that the work-related illness may have consequences that trigger the claim (liability-filling causality) is not a prerequisite for a listed occupational disease, but it is a prerequisite for a benefit (claim)

Lyme disease as BK 3102:

The general practitioner Dr. S. informed the defendant (Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege) that the plaintiff (53-year-old long-time forestry worker) was suffering from the consequences of Lyme disease, which he had most probably contracted through a tick bite during forestry work. He also suffers from severe back pain, which can be attributed to a considerable degeneration of the lumbar spine. No neurological pathology was found. At the end of February, a positive borrelia serology (IgM western blot: negative; IgG western blot: detection of several bands) was diagnosed. The test result was well compatible with a late stage of Lyme borreliosis. The plaintiff had no recollection of tick bites. Despite antibiotic treatment, there was no improvement; further treatment had to be discontinued due to a massive allergy. Neurologically, no clear evidence of Lyme disease or radicular damage could be found. An occupational physician stated that the plaintiff had been engaged in forestry and woodland work. The occupational requirements for BK 3102 were therefore likely to be met. The serological findings confirmed an infection with Borrelia burgdorferi, but did not allow any statement to be made about the stage of the disease.

Epidemiological data showed that one in five ticks (20%) in the home region is infected with Borrelia burgdorferi (Note: The degree of infestation varies from region to region in Germany, but is not unusually high. In relation to the whole of Germany, about 5-35% of ticks are infected with Borrelia, with adult ticks being infected to about 20%, nymphs to 10% and larvae to about 1%. After being bitten by an infected tick, the risk of transmission is approx. 5%, the risk of disease approx. 1%).

The recognition of an occupational disease and the granting of compensation benefits were rejected by the defendant BG. The causal connection between the disease and the occupational activity was possible, but not sufficiently probable. The existence of a borrelia-related illness was possible, but not proven. Furthermore, recognition as an occupational disease under No. 3102 "presupposes a special risk of infection that goes beyond the normal level. Such an increased risk did not exist in the plaintiff's area of work. Nor did the claimant himself remember a tick bite. This makes a connection between the occupational activity and the disease a mere presumption. A tick bite during private leisure time is equally possible.

The judgement: In its judgement, the SG ordered the defendant BG to recognize the plaintiff's Lyme disease as an occupational disease no. 3102 of the Annex to the BKV and to grant the statutory compensation benefits. The claimant was almost certainly suffering from Lyme borreliosis. It is at least probable that there is a causal connection between the plaintiff's work (working in the construction of forest and logging roads) and Lyme disease. The plaintiff had been exposed to an increased risk of infection. The evidence of an increased risk of infection allows the conclusion that the plaintiff contracted the communicable disease through his particular occupational exposure. There were no concrete indications that the disease was caused by non-occupational influences.

The last passage of the SG's ruling is of great clinical-legal relevance insofar as "proof of an increased risk of infection" due to the particular occupational exposure is sufficient for the recognition of an infectious disease according to No. 3102 of the BKVO. Proof of a particular risk of infection that goes beyond the normal level is not a prerequisite, as explained above. In the meantime, the Federal Social Court (BSG) has also issued an identical ruling on this matter: "It is sufficient that insured persons were exposed to a particular risk of infection", which was the case with the "Borrelia infestation of the working environment".

In order for the employers' liability insurance association to recognize Lyme disease as an occupational disease, it must be proven that the tick bit the insured person while they were carrying out their insured activity. In the case of forestry workers, professional hunters, agricultural contractors with soil cultivation and employees in horticulture, the German Social Accident Insurance Institution for the agricultural sector (LBG) can generally assume that the infection occurred during the performance of their professional activity.

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